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Is it too expensive to fight cancer? Analysis of incremental costs and benefits of the Croatian National Plan Against Cancer


This cost-effectiveness study analyses the expected impacts of activities proposed by the Croatian National Plan Against Cancer (NPAC) on cancer incidence and survival rates, as related to their respective costs. We evaluated the impact of the NPAC on two main outcomes, namely, reduced incidence and the improved survival of cancer patients, expressed as life years gained (LYGs), which enabled the calculation of incremental cost-effectiveness ratios (ICERs) in the form of cost per LYG. In the analysis of costs, we considered both the direct costs of NPAC activities as well as the wider indirect societal costs of cancer, thus permitting the calculation of the ICER both from the narrower national health insurer’s perspective (accounting only for the direct costs) and the wider societal perspective (accounting both for the direct and indirect costs). We estimated that on average, for all patients benefiting from the implementation of the NPAC in Croatia, an additional LYG would be yielded at the additional cost of €1.021 (societal perspective). The NPAC can, for some sites, even be considered a dominant intervention due to the negative cost/LYG ratio, meaning that it generates additional LYGs while at the same time, reducing total societal costs. Taking a narrower health insurer’s perspective (i.e., accounting only for the direct costs), the NPAC produces an additional LYG at an additional cost of €1.408. Both cost per LYG estimates can be considered cost-effective investment options.

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  1. Period over which the NPAC is to be implemented.


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We gratefully thank the current and former ministers of health of the Republic of Croatia, Dr Milan Kujundzic, PhD and Dr Vili Beros, PhD for their continued support and political leadership in the development of the National Plan Against Cancer. The work of Ana Bobinac was supported in part by the Croatian science fundation (UIP-2019-04-3721).


The work of Ana Bobinac was supported in part by the Croatian science fundation (UIP-2019-04-3721).

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All authors contributed to the study conception and design. The first draft of the manuscript was written by Luka Voncina, Ana Bobinac and Eduard Vrdoljak and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ana Bobinac.

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Vrdoljak, E., Sekerija, M., Plestina, S. et al. Is it too expensive to fight cancer? Analysis of incremental costs and benefits of the Croatian National Plan Against Cancer. Eur J Health Econ 22, 393–403 (2021).

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  • Economic evaluation
  • National plan against cancer
  • Cost per LYG
  • ICER

JEL Classification

  • I18 Government Policy
  • Regulation
  • Public Health